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PubMed1991

Focused psychiatric review: impacts on expense and utilization.

Focused Psychiatric Review, Aetna's inpatient mental health utilization review program, reduces length of stay and stabilizes admission rates and, as a consequence, reduces expenses, according to the study reported in this article. The program has greater impact on psychiatric than on substance abuse treatments. The best estimate of annual net program savings is $34.90 per covered employee, a return of $12.60 saved for each program dollar spent.

Data Collection↗
PubMedDate not supplied

Survey search: prevalence/effects of newer mental health care and cost management programs.

Three types of programs are beginning to capture the imagination of employers concerned about issues related to mental health care and its costs: utilization review, particularly via psychiatric PPOs and case management; Employee Assistance Programs; and substance abuse testing. The spread of these programs, the promise and problems they present and their effectiveness (where measured on a wide scale) are documented here, based on studies by a variety of researchers.

Data Collection↗
PubMed1992

Categorization of types of medical/psychiatry units based on level of acuity.

Medical/psychiatry units can be categorized by the level of acuity of medical and psychiatric illness. Type I units are categorized as those that primarily provide psychiatric care with a low level of medical acuity. Type II units include general medicine or medical subspecialty units that are associated with a psychiatric liaison service and provide low levels of psychiatric care to those admitted to the general medical setting. Type III and Type IV units are characterized by a true departure from the current ward settings and care for patients who have concurrent and more severe medical and psychiatric problems in a unified setting. Both of these units require special physical changes in the ward structure, additional nurse training, and coordinated physician coverage to function effectively.

Acute Disease↗
PubMed1990

The behavioral medicine service. An administrative model for biopsychosocial medical care, teaching, and research.

The biopsychosocial model has been promoted for its advantages in many important health problems. However, the lack of administrative practice models specifically designed to develop and promote the model hinder the development of systematic clinical applications. This article describes a successful clinical teaching and research practice, The Behavioral Medicine Service, that was conceptualized and developed based on the biopsychosocial model. Systematic planning enabled the service to take advantage of clinical, research, and teaching opportunities and to reduce the constraints imposed on development from within psychiatry and the institution. Advantages of the organizational model include multidisciplinary treatment teams, a systematic method of biopsychosocial assessment and management planning, and continuity of care between several settings: the medical-surgical wards of a general hospital; a behavioral medicine inpatient unit; and outpatient subspecialty clinics for chronic pain, chronic medical illness, anxiety and stress-related disorders, and drug and alcohol abuse. The Human Behavioral Pharmacology Laboratory forms the research arm of the service. Referrals of a diversity of medical and psychiatric problems create a unique learning opportunity for residents. Billing for multimodal team treatment, training residents, establishing clinical research, and managing a plethora of referrals were developmental challenges addressed by the service.

Behavioral Medicine↗
PubMed1978

Psychiatry and the fiscal third party.

Third-party payment has profound effects on such areas of psychiatry as confidentiality; diagnosis; the therapeutic relationship; psychiatry's identification with the rest of medicine and the role of nonphysician mental health professionals; psychiatric education; and the availability, type, location, and quality control of treatment. As third-party payment becomes increasingly frequent, psychiatrists will have to come to terms with its good and bad effects in hospitals and community mental health centers as well as in private practice.

Attitude of Health Personnel↗
PubMed1989

Current procedural terminology codes for psychiatric services.

Physicians' Current Procedural Terminology (CPT) is the system most commonly recognized by third-party payers for describing medical services in numerical codes for subsequent reimbursement. Adequate description of psychiatric services using CPT codes is an ongoing challenge. Psychiatrists have responded to the demands of third-party payers and peer review organizations for documentation and accountability by billing for specific services rather than by designating all care as psychotherapy. The authors present guidelines for using CPT codes to describe inpatient and outpatient psychiatric services and consultation. They also discuss continuing controversies, including regional diversity in the interpretation of codes by third-party payers, the risks of "gaming" the coding process, and the use of CPT codes by non-physician providers and the consequent mixing of data on service charges.

Abstracting and Indexing↗
PubMed1997

The costs of behavioral health care coverage.

Psychiatric and chemical dependency conditions can have significant financial implication for plan sponsors, but a variety of mechanisms are available to control these costs. The application of appropriately designed and implemented benefit designs in combination with managed behavioral health care protocols can have a significant return on investment for the plan sponsor.

Behavior Therapy↗
PubMed1988

The greening of the HMO: implications for prepaid psychiatry.

Over the past 15 years the health maintenance organization (HMO) movement has abandoned its social objectives in favor of economic ones. The early emphasis on making equitable and affordable health care available to populations has been superseded by concerns about profitability, market share, and consumer appeal. Psychiatric services, which came late in the HMO movement, were characterized by common values and priorities in the closed-panel HMOs of the 1970s. Trends toward independent practice associations (IPAs) and other open-panel systems, rising expectations, and the monetarization of health care are forcing prepaid psychiatrists to reassess their identity and roles.

Forecasting↗
PubMed1993

Ensuring services for persons with chronic mental illness under national health care reform.

People with chronic mental illness present complex challenges for the design of health care financing reforms. In this position statement from the committee on psychiatry and community of the Group for the Advancement of Psychiatry, the authors describe chronic and severe mental illnesses as psychiatric illnesses that require acute and ongoing psychiatric assessment and treatment, as chronic medical diseases that require ongoing rehabilitative services, and as persistent disabilities that need ongoing supportive care and social services. Any proposal for health care reform must ensure parity of chronic psychiatric illnesses with other psychiatric conditions. It must also reimburse psychiatric rehabilitation at parity with other medical rehabilitation and provide equal access to and reimbursement for broad ancillary health services that reduce costs and improve quality of life.

Chronic Disease↗
PubMed1991

Consultation-liaison psychiatry in western Europe. The European Consultation-Liaison Workgroup.

Consultation-liaison psychiatry (C-L) services have developed throughout Europe, largely as a result of individual local initiative. Reviews by contributors from 14 countries reveal similarities in national approaches and in the problems caused by inadequate resources, lack of recognition from psychiatric colleagues, and difficulties in integrating C-L with comprehensive systems of psychiatric care, which are mainly oriented toward community care. National C-L organizations and a recently established European Workgroup have focused attention on the clinical importance of C-L and the need to define national and local policies for its clinical role, staffing, and other resources. There is considerable and increasing interest in European C-L research.

Cross-Cultural Comparison↗
PubMed1976

Utilization of prepaid services by patients with psychiatric diagnoses.

The authors document and discuss the utilization of psychiatric services in a rural group practice before and after the institution of a prepaid health plan. They found that the utilization of psychiatric services increased dramatically during the first year of the plan's operation. The increase in outpatient utilization continued throughout the 3 years studied, but inpatient utilization decreased after the first year and later reached a level lower than that seen before the plan was instituted. One possible reason for the decline in inpatient utilization is that increased outpatient care prevents hospitalization.

Ambulatory Care↗
PubMed1985

The use of restraints on a general psychiatric unit.

A 9-month prospective study of all patients restrained on the acute psychiatric units of two general hospitals and a group of nonrestrained controls revealed significant demographic and diagnostic differences between restrained and nonrestrained patients. Restraint occurred more often in young, unmarried, seriously ill men with a previous history of violent behavior and previous psychiatric treatment. These characteristics were coupled with inadequate neuroleptic treatment and a perception of inadequate power authority (low staffing levels of male orderlies). There was a significantly higher frequency of a history of previous violence in restrained patients compared to nonrestrained patients on the same unit. These data have important clinical and legal implications for persons involved in making predictions of "dangerousness."

Adolescent↗
PubMed1993

Planning for the future of behavioral health services.

Psychiatric and chemical dependency services are increasingly being delivered through managed care with greater emphasis on ambulatory and outpatient treatments. Inpatient facilities can preserve their involvement in behavioral health services by actively developing a managed care product line. This article describes the nature of change in behavioral services, what competitive behavioral health providers will look like in the future, and the actions hospital administrators should be taking now.

Comprehensive Health Care↗
PubMedDate not supplied

The next generation of managed mental health care.

The rise in mental health claims and the tremendous expansion of psychiatric facilities and services have put payers and providers alike on the defensive. Payers cut benefits, while providers rush to justify even clearly needed care. The venturesome in both camps will be intrigued by General Telephone of California's comprehensive, managed mental health care program, combining the PPO concept with provider risk and strong case management, as described by the authors, Vice Presidents of Preferred Health Care, Ltd.

California↗
PubMed1977

Problems in analyzing the comparative costs of private versus public psychiatric care.

The authors outline the difficulties in attempting to compare the costs of service in various mental health settings, especially private practice and community mental health centers. Contributing to the difficulties are the differences in the populations served, differences in treatment modalities employed, and the different economic incentives operating in each setting. The authors stress the need for research on cost effectiveness as the basis for valid comparisons of various care settings.

Community Mental Health Services↗
PubMed1976

The broad role of Ego Functions Assessment.

The need for accurate assessment and accountability is of paramount professional concern to psychiatry. The authors state that ego functions assessment (EFA) is reliable and valid quantitative technique, useful for these purposes in a variety of psychiatric settings. They suggest the various uses of EFA in five such areas: Professional Standards Review Organizations (PSRO) and third-party funding, forensic psychiatry and legal responsibility, the monitoring of psychotherapeutic drugs, research and planning in psychotherapy, and psychological testing. The authors condlude the EFA is a dynamically sophisticated and easily learned form of mental status examination and that its refinement by extensive use and simplification is likely.

Adult↗
PubMed1986

Psychiatric services to adolescents: 1970-1980.

A study based on the National Institute of Mental Health's Sample Survey Program for 1970, 1975, and 1980 provides an overview of the services to adolescents supplied by the mental health sector. Data are presented mainly for nonfederal general hospitals, state and county hospitals, private psychiatric hospitals, and, to a lesser extent, outpatient clinics. Among the trends found by the analysis are that private psychiatric and private general hospitals admitted an increasing share of adolescents while state and county hospitals admitted fewer; the overall proportion of younger adolescents admitted for inpatient treatment increased; all types of study facilities except state and county hospitals admitted relatively low proportions of adolescent substance abusers; and the use of psychotropic drugs decreased in some types of facilities, especially for younger adolescents.

Adolescent↗